Sclerotherapy for leg varicose veins - Institute of Health Economics

Sclerotherapy for leg varicose veins
secondary changes due to previous venous thrombosis. These causes can lead to reflux,
obstruction or both. Consequently varicose veins tend to be both chronic and recurrent.
Most varicose veins are manifestations of primary venous insufficiency.
The prevalence of varicose veins is estimated to be between 2% and 40%
25. Although prevalence and incidence of varicose veins increase with age in both
genders, they appear to be more common in women than in men. Risk factors include
genetic predisposition, hormonal changes and pregnancy, obesity, lifestyle, venous
thrombosis, leg injury, and prolonged standing 3, 5, 6, 7, 18, 19, 21-24 .
2, 3, 5, 7, 8, 9-14, 16, 18-
Varicose veins can be asymptomatic, produce aesthetic damage and/or discomfort or
be responsible for functional and/or objective signs and symptoms of CVI (Expert
review, Document-reply #1) 2, 3, 6, 7, 8, 9-14, 16, 18-27 . Commonly reported symptoms include
local discomfort (aching, pain, itchiness, and burning sensation), generalized lower leg
symptoms (leg-tiredness, restless leg syndrome, heaviness, skin changes and
swelling/edema) and cramps.
Differentiation between symptomatic and asymptomatic varicose veins remains a
challenge. The symptoms are not clearly defined and not always related to the degree
or size of the varicose veins (Expert review, Document-reply #1) 2, 4, 27 . There is evidence to
suggest that the severity of discomfort produced by varicose veins is disproportionate
to the amount of the pathologic change present (Document-reply #1, Appendix D).
Varicose veins slowly progress with enlargement and distal extension and, if untreated,
may eventually lead to severe complications such as bleeding, thrombophlebitis, and
leg ulcer (venous ulceration) (Expert review, Document-reply #1) (Dunn, personal
communication) 2, 7, 8, 12, 16, 18, 21-24, 28 . Varicose veins (particularly small ones) do not
usually cause severe complications even if they are present over very long periods of
time (Dunn, personal communication) 8, 14, 15, 23, 24 . Some evidence suggests that about 50%
of patients with significant superficial venous insufficiency if left untreated will
eventually suffer from CVI with severe complications 29 . However, the exact incidence
of significant symptoms or severe complications in these patients has not been clearly
determined yet (Soriano, personal communication) 4 .
Treatment
The actual cause of varicose veins of the legs remains unclear and there is no known
cure 2, 7, 10, 14, 19-23, 30, 31 . Treatment is palliative and aims to relieve symptoms, prevent
and/or manage potentially disabling complications, and improve cosmetic appearance.
Asymptomatic varicose veins may be considered for treatment to improve cosmetic
appearance (Dunn, personal communication) 3, 4, 14, 19, 22, 23 . Treatment for telangiectasia
and reticular varicosities is most commonly performed for cosmetic concerns and may
not be considered medically necessary 3, 14, 15, 19, 20, 23, 24, 26, 30, 32-35 . Although most of the
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